bpcyclist, are you severely depressed right now? Or is psychosis your main issue? I am no doctor and I don't have the same brain as you, or the same illness course that you have had, or all of the same reactions to medications you have had (and vice versa). However, I can't help but think that continuing to add add add a mix of really powerful stuff (on both ends of the spectrum) to an already hefty cocktail, wouldn't make for a very confusing and chaotic situation.

When I saw you mention the stimulant, I had a very similar reaction as bluebicycle. It's hard not to. If you're psychotic, I can't in a million years see how a stimulant could help? I don't know. Me knowing my own situation, and knowing all of the medications you have in your cocktail, I would see that for me, reducing or eliminating something might be a good plan to consider, if depression is a major concern. As for psychosis, I am a fan of Trilafon. You've read my posts on that. I took double what you've been taking and did well. I can't say you will, but again, if some doctor said that instead of fixing my psychosis with an antipsychotic they'd give me a stimulant? I'd declare "YOU ARE CRAZY!!!!!" But that's just me.

Another point to consider that I think some, not all, will relate to: Antidepressants were the single most destabilizing medications I have ever been put on, regardless of whether or not I was also on a moodstabilizer and antipsychotic! When I say destabilizing, I don't just mean "making me manic". I mean "making me depressed", too. An antidepressant making a bipolar person depressed? Yes! They screwed me up, royally! Sometimes what seems like an angel is actually a devil in disguise. We think we're being granted a great deal by such a risky bugger, but in the end it is like a deal with the devil that eventually goes bad.

Some moodstabiizers are not the most depression friendly for everyone. Remember I called Depakote "Depressakote"? I was so depressed for such a long time I agreed to ECT. Then they put me back on the Depakote, and the depression came back. They had the brilliant idea of putting me on Wellbutrin SR, and I got worse yet. I only started to improve when that stuff was finally scrapped. Not saying Depakote is bad for everyone. It can be a lifesaver. Or that Wellbutrin is bad. But for me, my sanity came back long-term only after certain elements of my cocktail were removed.